Abstract
Spondyloarthritis (SpA) encompasses a broad spectrum of conditions occurring from childhood to middle age. Key features of SpA include axial and peripheral arthritis, enthesitis, extra-articular manifestations, and a strong association with HLA-B27. These features are common across the ages but there are important differences between juvenile and adult onset disease. Juvenile SpA predominantly affects the peripheral joints and the incidence of axial arthritis increases with age. Enthesitis is important in early disease. This review article highlights the similarities and differences between juvenile and adult SpA including classification, pathogenesis, clinical features, imaging, therapeutic strategies, and disease outcomes. In addition, the impact of the biological transition from childhood to adulthood is explored including the importance of musculoskeletal and immunological maturation. We discuss how the changes associated with adolescence may be important in explaining age-related differences in the clinical phenotype between juvenile and adult SpA and their implications for the treatment of juvenile SpA.
Highlights
The spondyloarthropathies (SpAs) are a heterogeneous group of inflammatory arthropathies affecting both the peripheral and axial joints
juvenile SpA (JSpA) is classified differently from adult SpA as enthesitis related arthritis (ERA) which encompasses both axial and peripheral arthritis, and juvenile onset psoriatic arthritis, both of which are classified within the umbrella term juvenile idiopathic arthritis (JIA) [5]
Adult SpA is classified by the Assessment of SpA International Society (ASAS) criteria which have been developed separating axial and peripheral SpA but encompassing the broad spectrum of disease including psoriatic arthritis, enteropathic arthritis, and reactive arthritis (Table 1) [6]
Summary
Corinne Fisher * 1,2,3 , Coziana Ciurtin 1,2,4, Maria Leandro 1,2,4, Debajit Sen 1,2,3† and Lucy R. Edited by: Miroslav Harjacek, United Arab Emirates University, United Arab Emirates. Reviewed by: Ana Filipa Mourão, Hospital de Egas Moniz, Portugal Robert Allen Colbert, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), United States. Specialty section: This article was submitted to Rheumatology, a section of the journal
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